Rare malignancies of immune system studied

Implants may bring a new disease to cancer patients with mastectomies, N.Y. Times says 

Can breast cancer implants give a woman who's had a mastectomy another cancer?

According to a recent article by Denise Grady in The New York Times, the answer is a definite yes.

The new cancer, it indicates, may not be breast cancer "but a rare malignancy of the immune system —  caused by the implants used to rebuild her chest."

The disease, anaplastic large-cell lymphoma, is a cancer that's "been linked to implants with a textured or slightly roughened surface, rather than a smooth covering," the piece says.

Although the federal Food and Drug Administration first reported a link between implants and the disease in 2011, an FDA update in March linked nine deaths to the implants and helped raise awareness, Grady's article notes.  

The FDA has also received 359 voluntary reports of implant-associated lymphoma from doctors or patients around the world.

That number, the story says, "is expected to rise as more doctors and pathologists recognize the connection between the implants and the disease."

As of now, however, no implants have been recalled — and "what's inside the implant, silicone or saline, seems to make no difference."

Between 2000 and 2016, the number of U.S. breast augmentations rose 37 percent — "and reconstruction after mastectomy rose 39 percent," Grady writes.

"Annually, nearly 400,000 women in the United States get breast implants, about 300,000 for cosmetic enlargement and about 100,000 for reconstruction after cancer, according to the American Society of Plastic Surgeons," the story adds.

Lymphoma, if detected early, is often treatable and rarely fatal — although its symptoms "usually include painful swelling and fluid buildup around the implant. Sometimes there are lumps in the breast or armpit."

Dr. Mark W. Clemens II

In cases with bad outcomes, the Times quotes Dr. Mark W. Clemens II, a plastic surgeon and expert on the disease at the University of Texas MD Anderson Cancer Center in Houston, "it was usually because they were not treated or there was a major delay in treatment, on the level of years."

Clemens believes that as late as 2015, "only about 30 percent of plastic surgeons were routinely discussing the cancer with patients," the Times piece says.

The newspaper also notes that what causes the disease isn't known. "One theory," Grady's story postures, "is that bacteria may cling to textured implants and form a coating called a biofilm that stirs up the immune system and causes persistent inflammation, which may eventually lead to lymphoma."

Clemens noted that researchers are also looking for mutations that might contribute to the disease.

More information about women's difficulties after reconstruction can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

2,014 women with mastectomies studied

Radiation after some breast reconstructions can cause extra complications, report says 

Radiation might dramatically affect the results of breast reconstruction.

According to a recent report on Breastcancer.org, new research "suggests that radiation after implant reconstruction seems to cause more complications than radiation given after autologous reconstruction [rebuilding the breast with tissue from your own body]."

The study, presented at the annual San Antonio Breast Cancer Symposium, "looked at medical data and collected patient reports on reconstruction outcomes from 2,014 women who had mastectomy and breast reconstruction."

Two years after radiation was completed, 39% of women who'd undergone implant reconstruction had at least one complication — compared to 26% for those who'd had autologous reconstruction.

Worse yet, the study showed radiation was "linked to more than doubling the risk of complications" after the implants but was "not associated with a higher risk of complications" in women who'd undergone the other treatment.

Complications included "infection at the surgery site, hematoma (collection of blood outside blood vessels), capsular contraction, and other problems."

Those with implants who'd been treated with radiation also were less satisfied with their results than those who didn't get radiation, the study indicated.

Dr. Reshma Jagsi

Dr. Reshma Jagsi, lead author of the study and deputy chair of radiation oncology at the University of Michigan, contended that women who planned to receive post-mastectomy radiation therapy needed to be informed of the "significant impact" the study found regarding radiation and implant reconstruction. 

And conversely, she said, "those who plan to pursue autologous reconstruction…may derive some reassurance" from the statistics.

Dr. Marisa Weiss, Breastcancer.org founder, added that "one thing I recommend as a breast radiation oncologist who deals with this issue all the time is to make sure the implant you get is fairly close to your original size." The problem with a bigger size, she noted, is that the skin has already "lost a lot of its blood supply with mastectomy, it's been stretched, it's maybe been subjected to chemo, it's not the happiest camper on the block."

After mastectomies, radiation normally is recommended if the cancer is about two inches long, if it's spread to four or more lymph nodes, if it's spread to the skin, or if cancer cells are found in the rim of tissue around the disease (the margins).

Post-surgery feelings of patients are addressed in detail in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.